Abstract
A Randomized, Double-Blind, Placebo-Controlled Trial of Spironolactone
for Hypokalemia in CAPD Patients
SomchaiYongsiri M.D. 1 Suriya Prongnamchai, M.D. 1 PechngamTengpraettanakorn, M.D. 1
Rachaneeporn Chueansuwan, M.D. 1 Siriporn Tangjaturonrasme, M.D. 1 Jiranuch
Thammakumpee, M.D.2 Pakaphan Dinchuthai, M.D. 1
1
Facutly of Medicine, Burapha University, Chonburi, Thailand
2
Internal Medicine Department, Chonburi Hospital, Thailand
Background
The incidence of hypokalemia in CAPD patients is about 15-60%, leading to significant
complications such as weakness, malnutrition and death. There was no standard treatment
other than potassium supplement in this setting.
Methods
This is a Randomized, double-blind, placebo-controlled, cross over study in hypokalemic
CAPD patients. Study intervention is 4 weeks of oral spironolactone 25 mg/d or placebo,
cross over after 2 weeks wash out period. Primary outcome is the difference of serum
potassium before and after 4 weeks of spironolactone treatment. We also measure total daily
potassium excretion, defined by the sum of 24-hr urine potassium and peritoneal fluid
potassium excretion. Serum potassium is measured every 2 weeks, serum magnesium, urine
and peritoneal fluid potassium measured before and after each treatment period.
Results
We enrolled 24 patients, 20 completed the cross over study. Ten patients were anuric. Total
dose of potassium supplement were not different throughout study period. Serum potassium
before and after study intervention were not significantly different in the both groups (4.23+/0.64 vs. 3.90+/-0.59 mEq/L for spironolactone p=0.077 and 3.84+/-0.62 vs. 3.91+/-0.52 for
placebo p=0.551). Total 24-hour potassium, magnesium, sodium excretion, urine volume and
ultrafiltration volume were not affected by spironolactone or placebo. There was1 episode of
hyperkalemia (5.6 mEq/L) during spironolactone treatment period.
Conclusions
Spironolactone 25 mg/d does not have significant effect on serum potassium or urine and
peritoneal excretion rate in hypokalemic CAPD patents.
Keywords: End stage renal disease, hypokalemia, peritoneal dialysis, spironolactone